INFECTIONS TiKi TaKa

. Isoniazid side effect:

. Peripheral neuropathy .. Tx: Vit. B 6 (Pyridoxine).

. CEREBRAL TOXOPLASMOSIS:

. Multiple ring enhancing lesions causing headache & hemiparesis.

. Prophylaxis = TMP-SMX = Trimethoprim - Sulfamethoxazole.

. Treatment = SDZ-PMT = Sulfadiazine - Pyrimethamine.

. MYCO-BACTERIAL AVIUM "MAV" complex:

. HIV pt with un-explained fever & cough with CD 4 count < 50.

. AZITHROMYCIN is the best prophylaxis for HIV with MAV.

. FEBRILE NEUTROPENIA:

. Fever > 38.3 + Neutrophils < 1500.

. Management: Admission + CEFEPIME I.V.

. Mucormycosis:

. Caused by fungus RHIZOPUS.

. Require aggressive surgical debridement + I.V. AMPHOTERICIN B.

. ASPERGILLOSIS:

. Immunocompromised pt. with pulmonary symptoms.

. CXR: consolidation in the upper lobe.

. CT: HALO sign.

. HISTOPLASMOSIS:

. Pulm. symps.

. CXR: Hilar adenopathy.

. Triad of palatal ulcers + splenomegaly + Thrombocytopenia.

. COCCIDIODIOMYCOSIS:

. Pulm. symps.

. Erythema multiforme or erythema nodosum.

. BLASTOMYCOSIS:

. Immunodefecient pt. with pulm. symps.

. YEAST :)

. COCCIDIOMYCOSIS:

. ARIZONA.

. Nonspecific lung syms + erythema multiforme + erythema nodosum + Arthralgia.

. Any dog bite ... An attempt to capture the dog is tried 1st.

. If the dog is not captured .. It is assumed RABID: Give post-exposure prophylaxis.

. If the dog is captured .. But doesn't show any features of Rabies: Observe for 10 days.

. If it developed any Rabies features: Give post-exp. prophylaxis.

. If the bite involves the head & neck: Post exposure prophylaxis is indicated IMMEDIATELY.

. Viral (HSV) Encephalitis:

. Fever + confusion.

. Hemiparesis + Hyperreflexia.

. Cranial n. palsies + focal deficits.

. CSF: ++ ptn, ++ WBCS, ++ Lymphocytes.

. Normal glucose.

. Dx: PCR.

. Tx: I.V. ACYCLOVIR.

. Rt. sided endocarditis:

. Should be considered in pts. with H/O of I.V. drug abuse.

. Tx: VANCOMYCIN.

. Directed against MRSA & Streptococci.

. BABESIOSIS:

. Tick borne disease.

. Parasite enters the RBC causing hemolysis.

. Symptoms: JAUNDICE .. HEMOGLOBINURIA .. RENAL FAILURE .. DEATH.

. Typical pt.: > 40 ys .. Without a spleen or immunocompromised.

. LABS: INTRAVASCULAR HEMOLYSIS: -- RBCs,--WBCs,--Platelets.

-- Serum complement.

++ ESR, ++ Lymphocytes.

. Dx: GIEMSA stain.

. Tx: ATOVAQUONE - AZITHROMYCIN.

. Any transplant pt. should have TMP-SMX for prophylaxis against (PCP) pneumo-cystis carinii pneumonia.

. "AIHI" Auto-immune Hemolytic Anemia is one of the complications of INFECTIOUS MONONUCLEOSIS.

. Empiric antibiotics for bacterial meningitis:

. VANCOMYCIN + AMPICILLIN + CEFEPIME + CORTICOSTEROIDS.

. HIV +ve pts are at high risk for T.B.

. A pt with +ve PPD Tuberculin test i.e. > 5mm induration:

. Should have INH (Isoniazid) & Vit.B6 (Pyridoxine) for 9 months as a prophylaxis.

. EHRILICHIOSIS:

. SPOTLESS RMSF.

. TICK BITE.

. Systemic symptoms.

. LEUKOPENIA & THROMBOCYTOPENIA.

. ++ ALT & AST.

. Tx: DOXYCYCLINE.

. ENTERO-HEMORRHAGIC E-COLI:

. Bloody diarrhea.

. Abd. pain.

. NO FEVER.

. No travel H/O.

. E-Coli = TRAVELER's diarrhea.

. Whenever a health care worker is exposed to HIV:

. Draw his blood for HIV serology.

. Start anti-retro-viral therapy with 3 drugs without delay while awaiting the results of HIV serology.

. HIV pts with CD 4 cell count < 50:

. Require prophylaxis against MAV complex with AZITHROMYCIN.

. CRYPTO-COCCAL meningitis:

. Caused by encapsulated yeast.

. HIV pt. with meningitis.

. Tx: IV Amphotericin + FLUCYTOSINE.

. Tx of primary syphilis:

. Single I.M. BENZATHINE PENICILLIN.

. If the pt is allergic to penicillin: Give either single dose of AZITHROMYCIN or 2 weeks course of DOXYCYCLINE.

. Lyme dis. pt. if pregnant, lactating or child < 8ys:

. Don't give DOXYCYCLINE but give AMOXICILLIN.

. Malignant Otitis externa:

. D.M. pt. with ear pain & granulation tissue at the auditory canal.

. Caused by pseudomonas Aeruginosa.

. Recall of a tick bite is not the main stay of the diagnosis of LYME disease caused by BORRELIA BURGDORFERI !

. UTI INFECTION:

. Acidic urine = E-Coli.

. Alkaline urine = Proteus.

. Rash of measles & Rubella r za same ... BUT:

. Measles is accompanied by KOPLIK's spots.

. Rubella is associated with ARTHRITIS.

. TRICHINELLOSIS:

. GIT complaints.

. + Triad of: Peri-orbital edema + Myositis + Eosinophilia.

. Other clues .. Splinter or sub-ungal hemorrhages.

. Actinomycosis:

. Infection at the neck in a diabetic pt.

. Serosanguinous fluid draining from a defect in the center of the lesion.

. Culture: Gram +ve branching bacteria.

. Tx: I.V. Penicillin.

. Actinomycosis is a bacteria not a fungus so don't ttt it with Amphotericin !!

. Lesion: Slowly progressive non tender indurated mass evolving into multiple abscesses with draining sinus tracts with sulfur yellowish granules !

. CMV Pneumonitis !!!!

. 45 days post Bone Marrow transplant recipients.

. CXR: Multi-focal diffuse patch infiltrates.

. Oral thrush.

. CMV colitis: Abdominal tenderness

. Toxic shock $yndrome:

. H/O of NASAL PACKING or MENSTRUATION TAMPOONS.

. Fever < 38.9 c.

. Hypotension < 90/60 mmHg.

. Rash & thrombocytopenia.

. Multisystem involvement (Vomiting & Diarrhea & Myalgia).

. PCP = PNEUMOCYSTIS CARINII PNEUMONIA:

. HIV pt. with CD4 < 200.

. Non prod. cough, dyspnea, fever, hypoxia.

. Bilateral interstitial infiltrates on CXR.

. Tx: TMP-SMX.

. Use steroids if: PaO2 < 70 mmHg or A-a gradient > 35 mmHg.

. NOCARDIOSIS:

. Crooked, branching, beaded, gram +ve partially acid fast filaments on microscopy.

. Tx: TMP-SMX.

. Symptomatic CAT scratch disease:

. Lymphadenopathy & Systemic symptoms.

. Tx: AZITHROMYCIN.

. PSEUDOMONAS AERUGINOSA:

. Gram -ve bacilli in the sputum of an intubated ICU pt. + fever + leukocytosis.

. Tx: CEFEPIME (4th g. cephalosporin) or PIPERACILLIN - TAZOBACTAM !

. Ceftriaxone is not effective against Pseudomonas.

. U should STOP it!

. Valvular diseases:

. MR is the most common valvular abnormality not related to IV drug abuse.

. If IV drug abuser .. TR is the most common.

. D.M. pts with foot ulcer who developed osteo-myelitis:

. The route of infection is CONTAGIOUS SPREAD.

. A nail puncture wound resulting in Osteomyelitis in an adult:

. is due to Pseudomonas Aeruginosa.

. Bacterial Meningitis with meningococcemia:

. Sudden onset fever + Neck stiffness + Nausea + Headache + Myalgia.

. Hypotension + Tachycardia + Myalgia + Purpuric skin lesions.

. CSF findings of BACTERIAL cause:

** ++ WBCs .. 2000 (N: 0-5).

** Glucose .. 20 (N: 40-70).

** ++ Protein .. 175 (N: <40).

. Lyme disease:

. Is not associated with purpura.

. But associated with erythema migrans.

. With characteristic bull's eye appearance !

. INFLUENZA MANAGEMENT:

. Most pts with INFLUENZA are ttt with BED REST & SIMPLE ANALGESIA e.g. ACETAMINOPHEN.

. Anti-viral medications reduce the duration of influenza,

. But they are only effective if administered within 48 hours of the onset of illness. . Amantadine & Rimantadine are only effective against type A.

. Zanamivir & Oseltamivir r only effective against both type A & B.

. INDINAVIR (Protease inhibitor):

. Anti-retroviral therapy.

. Causing high creatinine & hematuria.

. Needle shaped crystals in sediment: causing crystal induced nephropathy!

. BACILLARY ANGIOMATOSIS:

. Caused by BARTONELLA HENSELAE.

. Manifest as several cutaneous & visceral angioma like blood vessels.

. EXOPHYTIC PURPLE SKIN LESIONS.

. I.V. drug abusers r more prone to developing tricuspid endocarditis:

. Caused by STAPHYLOCOCCAL AUREUS.

. Fragments of the vegetation can embolize to the lungs,

. Causing the characteristic nodular infiltrate with cavitation.

. PID PELVIC INFLAMMATORY DISEASE :

. Any PID .. Give .. Chlamydia (Azithromycin) + Gonorrhea (Ceftriaxone).

. Any PID pt sh'd be routinely screened for $yphilis .. HIV .. HBV .. PAP smear.

. 2ry SYPHILIS:

. Maculopapular rash involving the palms & soles + Generalized lymphadenopathy.

. Spirochete infection.

. PNEUMONIAS:

. POST-INFLUENZA: STAPH. AUREUS.

. HIV: PCP.

. D.M. & Alcoholics: KLEBSIELLA.

. C.F. & Bronchiectasis: PSEUDOMONAS.

. Atypical $ dry cough: MYCOPLASMA.

. Aspiration: ANAEROBES.

. o"H"io----> "H"ISTOPLASMOSIS:

. HIV pt with CD 4 cell count <100.

. T.B. like pulm. syms with FHMA & weight loss.

. HEPATOSPLENOMEGOLY + Palatal ulcers.

. CXR: Bilateral reticulonodular opacities.

. Dx: URINE ANTIGEN.

. Tx: ITRACONAZOLE.

Dr. Wael Tawfic Mohamed